Winding up in the emergency room is bad enough. But the California Supreme Court ruled Thursday that patients no longer have to worry about getting billed for emergency treatment charges that their HMOs fail to pay.

Health maintenance organizations and patient advocates hailed the decision as an important protection against gouging by hospitals and physicians. But doctors said it would encourage greedy HMOs to underpay them and that that could put emergency rooms in jeopardy.

The decision resolves one part of a contentious debate that has vexed courts, lawmakers and regulators for years. But it leaves open the question of what constitutes reasonable payment for emergency services. Regulations require HMOs to pay hospitals and physicians reasonable fees but do not set out specific amounts.

I’ve been following medical policy for a while, and fortunately HMO penetration of the market is pretty low where I practice. For all the time I’ve been watching, I’ve never heard that HMO’s pay too much for anything; indeed, they drive a very hard bargain (they aren’t stupid, and they don’t like to part with money).

Because their hard bargains work against the interests of the docs (the ones providing medical care) many times docs would rather not sign a bad deal, and choose to a) bill for the value of their service, and b) put pressure on the HMO through the patient to bargain better. I’m not in Cal, and don’t know the details of the negotiations they had recently, but apparently when no bargain was struck between the Cal docs and HMO’s under a legislatively-sponsored negotiation, that’s the pretext for this decision.

Docs can sue the HMO for the balance of the bill, which will never happen as the legal fees would vastly outstrip the balance of the individual bill (though I wonder about class-action in this case…I’m not a lawyer, can anyone fill me in?)

Another reason for docs not already practicing in Cal to choose somewhere else.

Update: Shadowfax weighs in, and points out that now insurers have no reason to negotiate with EP’s’ as there’s no leverage to bargain with.

I cannot believe this is happening in a civilized society (even California):

California Supreme Court allows good Samaritans to be sued for nonmedical care

The ruling stems from a case in which a woman pulled a crash victim from a car ‘like a rag doll,’ allegedly aggravating a vertebrae injury.

By Carol J. Williams December 19, 2008

Being a good Samaritan in California just got a little riskier. The California Supreme Court ruled Thursday that a young woman who pulled a co-worker from a crashed vehicle isn’t immune from civil liability because the care she rendered wasn’t medical.

The divided high court appeared to signal that rescue efforts are the responsibility of trained professionals. It was also thought to be the first ruling by the court that someone who intervened in an accident in good faith could be sued.

This will have a chilling effect on all Good Samaritans, and not just in California.

In case you didn’t get the message, here’s a Professor of Constitutional and Bioethics Law at USC:

Noting that he would be reluctant himself to step in to aid a crash victim with potential spinal injuries, Shapiro said the court’s message was that emergency care "should be left to medical professionals."

(Also, fires should only be fought by Firemen, so be sure and let your neighbor’s house burn down; don’t keep the mugger from beating the old lady, law enforcement is for the Police only, etc).

Did this Professor of Law not think about the lives saved by CPR every year, and how this will be interpreted by them? Bystander CPR, and the heroic actions of many a Good Samaritan, are endangered by decisions like this. That trust in your fellow man, and a belief that government is run by reasonable people, is perishable. This kind of ruling will kill it, for good. Horrible.

Prepare to burn to death in your car as people drive by, unwilling to be victimized by a legal class without scruples and a society without morals

I sincerely hope there’s an appeal, to benefit at least good sense if not human decency.

The court has sent a signal to the people of California: don’t get involved. If someone’s drowning, don’t jump in the lake and save them. If someone’s trapped in a car that’s about to explode, sit there and watch the show. Just make a phone call, and who cares that it might be several minutes before an EMS team can make it to the scene? If you sit on your hands, no one can sue you for all you’re worth.

Predictably, their post is better than mine, making the same points and others, so make sure you read it all.